Chronically high triponin levels

[Tzs1981rn]

Could anyone offer any insight as to why a patint would have serum tiponin levels in the range of 40.4 to 76.3 without any EKG changes? On admission the levels were around 40, the next draw they were 60, the next they were 40, and then in the 70's. They were tested daily after this and never produced any type of trend. She never complains of any pain.The patient is an 82 year old female admitted with right lower lobe pneumonia, with spo2 says of 96% on room air and stable bp around 120-130/60-70 consistently. Pulse in the 80's. Her history includes dementia (and she is quite forgetful), HTN, high cholesterol, pacer placement (though she could not tell us why and no family was present or reachable by phone), and rheumatoid arthritis. She lives in an assisted living facility, though I think a SNF will be more appropriate on discharge given her confusion and disorientation if it doesn't improve. On prior admissions over the past 5 years, she had consistently high triponins with similar levels.Anyway, the cardiologists have ordered echo and her EF is 40% with no other major abnormalities. Ekg did not show anything suspicious per cardiologists. On telemetry she was running NSR 80's with occasional PAC's. No paced beats captured. I asked the hospitalist what would cause her symptoms an he said "some people just have high tripoonins." it sounded like an "i don't know" to me. I wasn't able to ask the cardiologist because he didn't come up on my shift.I work on a medical floor, but I figured I would get more responses on the cardiac board :)Thank you in advance for your input. Curiosity has gotten the better of me and I couldn't really find anything with a quick Internet search.

[KatieMI, BSN, MSN, RN]

Combination of CHF, HTN and resulting decreased renal perfusion/coming RF, as just one and most obvious probability. Checking BUN/creatinine/GFR would make sense for me.

Here is a good article about the subject:

CHEST Journal | Article

[Tzs1981rn]

Thank you - I will read over the article :)

I love that we have a forum where we can help each other out!

[BrnEyedGirl, BSN, MSN, RN, APRN]

Also, pacer wires often cause an elevated troponin.

[dianah, ASN]

RN-Cardiac, is that just immediately post-implant or can trops remain elevated years afterward?

[dianah, ASN]

Here's another article re: rise in troponins: cardiac VS non-cardiac

Troponin elevation in coronary vs. non-coronary disease

[Tzs1981rn]

Thank you for the great articles. I now have a better understanding as to why her triponins were so high. She does have impaired renal function. Thank you again!

[GrinchyRN]

My guess would be a combination of RA as well as renal issues from chronic HTN.

[turnforthenurse, MSN, NP]

Troponin leak from heart failure or renal failure. We get patients with critically elevated troponins but after being seen by a cardiologist, it is non-ischemic in nature and due to their comorbidities.